Provider Demographics
NPI:1952595969
Name:VELLA, RAYMOND MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MARK
Last Name:VELLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:365 PEARSON DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3360
Mailing Address - Country:US
Mailing Address - Phone:559-781-1378
Mailing Address - Fax:559-781-3024
Practice Address - Street 1:365 PEARSON DR
Practice Address - Street 2:SUITE 8
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3360
Practice Address - Country:US
Practice Address - Phone:559-781-1378
Practice Address - Fax:559-781-3024
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-02
Last Update Date:2007-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11801Medicare PIN